Patient Expectations of Hip and Knee Joint Replacement Surgery and Postoperative Health Status

  • Marita Cross
  • Helen Lapsley
  • Annica Barcenilla
  • David Parker
  • Myles Coolican
  • Lyn March
Original Research Article


Objective: To explore the relationship between preoperative patient expectations and postoperative health status in patients undergoing joint replacement surgery, with particular emphasis on the types of expectations held by patients.

Methods: Respondents completed the Hospital for Special Surgery (HSS) Hip/Knee Replacement Expectations Questionnaires pre-surgery, in addition to the Western Ontario and McMaster Osteoarthritis Index (WOMAC™) and the Short-Form 36-Item (SF-36) Health Survey and the Arthritis Self-Efficacy Scale. The WOMAC™ Index and SF-36 were also completed 3 and 6 months post-surgery.

Results: A total of 106 patients (total hip replacement [THR] = 28; total knee replacement [TKR] = 78) completed questionnaires. No differences were seen in overall expectations between males and females or older or younger patients, although some differences between the age groups were seen for individual expectations on the HSS expectations questionnaires. For THR, a higher rating of the importance of expectations was correlated with a lesser improvement in pain from pre-surgery to 3 months post-surgery, whereas for TKR, a higher rating of expectations was associated with a greater improvement in function to 6 months post-surgery.

Conclusions: Patients have high expectations of surgery, which are correlated with post-surgery pain and function. Identifying the broad range of expectations may be helpful in preparation for surgery and gaining greater satisfaction with outcomes.


Total Knee Replacement Importance Score Preoperative Expectation Total Knee Replacement Patient McMaster Osteoarthritis Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Funding for this study was received from the Australian National Health and Medical Research Council and The Lincoln Centre. D. Parker is a consultant for Stryker Orthopaedics. The remaining authors have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 2003; 18(7): 872–8PubMedCrossRefGoogle Scholar
  2. 2.
    Eisler A, Svensson O, Tengstrom A, et al. Patient expectation and satisfaction in revision total hip arthroplasty. J Arthroplasty 2002; 17(4): 457–62PubMedCrossRefGoogle Scholar
  3. 3.
    Mancuso CA, Salvati EA, Johanson NA, et al. Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplasty 1997; 12(4): 387–96PubMedCrossRefGoogle Scholar
  4. 4.
    Mahomed NN, Liang MH, Cook EF, et al. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. J Rheumatol 2002; 29(6): 1273–9PubMedGoogle Scholar
  5. 5.
    March LM, Cross M, Tribe KL, et al. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage 2004; 12(5): 400–8PubMedCrossRefGoogle Scholar
  6. 6.
    Bachmeier CJM, March LM, Cross MJ, et al. A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage 2001; 9(2): 137–46PubMedCrossRefGoogle Scholar
  7. 7.
    Mancuso CA, Sculco TP, Wickiewicz TL, et al. Patients’ expectations of knee surgery. J Bone Joint Surg Am 2001; 83-A(7): 1005–12PubMedGoogle Scholar
  8. 8.
    Ware JE, Sherbourne CD. The MOS 36-Item Short Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care 1992; 30(6): 473–83PubMedCrossRefGoogle Scholar
  9. 9.
    Bellamy N. WOMAC Osteoarthritis Index: a user’s guide. London (ON): University of Western Ontario, 1995Google Scholar
  10. 10.
    Lorig K, Chastain R, Ung E, et al. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 1989; 32(1): 37–44PubMedCrossRefGoogle Scholar
  11. 11.
    Van Den Akker-Scheek I, Stevens M, Groothoff JW, et al. Pre-operative or post-operative self-efficacy: which is a better predictor of outcome after total hip or knee arthroplasty? Patient Educ Couns 2007; 66: 92–99PubMedCrossRefGoogle Scholar
  12. 12.
    Jones CA, Voaklander DC, Johnston DW, et al. The effect of age on pain, function and quality of life after total hip and knee arthroplasty. Arch Int Med 2001; 161: 454–60CrossRefGoogle Scholar
  13. 13.
    March LM, Cross MJ, Lapsley HM, et al. Outcomes after hip or knee replacement surgery for osteoarthritis: a prospective cohort study comparing patients’ quality of life before and after surgery with age-related population norms. Med J Aust 1999; 171: 235–38PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Marita Cross
    • 1
  • Helen Lapsley
    • 2
  • Annica Barcenilla
    • 1
  • David Parker
    • 3
  • Myles Coolican
    • 3
  • Lyn March
    • 1
  1. 1.Institute of Bone & Joint ResearchUniversity of SydneySydneyAustralia
  2. 2.Centre of National Research on DisabilityUniversity of QueenslandBrisbaneAustralia
  3. 3.Sydney Orthopaedic Research Institute ChatswoodSydneyAustralia

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